Provider Demographics
NPI:1396986030
Name:NASH-SPACEK, DEZERAE M (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:DEZERAE
Middle Name:M
Last Name:NASH-SPACEK
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 POPLAR HILL CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-4279
Mailing Address - Country:US
Mailing Address - Phone:615-319-0069
Mailing Address - Fax:
Practice Address - Street 1:2400 CRESTMOOR RD
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2032
Practice Address - Country:US
Practice Address - Phone:615-298-2329
Practice Address - Fax:613-298-1248
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2112101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional